Analysis of Factors That May Affect the Effectiveness of Ketogenic Diet Treatment in Pediatric and Adolescent Patients.

Anna Winczewska-Wiktor,Paulina Komasińska-Piotrowska,Barbara Steinborn,Adam Sebastian Hirschfeld,Magdalena Badura-Stronka

doi:10.3390/jcm11030606

Anna Winczewska-Wiktor, Paulina Komasińska-Piotrowska + Show 3 more

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https://doi.org/10.3390/jcm11030606

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Abstract

Purpose. The aim was to find predictors for ketogenic diet (KD) treatment effectiveness. In addition, recognized factors influencing the efficacy of KD were analyzed based on the ILAE (International League Against Epilepsy) proposed Classification and Definition of the Epilepsy Syndromes. Methods. A sample of 42 patients treated with KD were analyzed. The effectiveness of KD was assessed according to the type of diet, the type of seizures, and the known (KE) or undetermined genetic etiology (UNKE). The group of KE consisted of patients with CACNA1S, CHD2, DEPDC5, KIF1A, PIGN, SCN1A, SCN8A, SLC2A1, SYNGAP1 pathogenic variants. The usefulness of the new Classification and Definition of Epilepsy Syndromes proposed by the ILAE was evaluated. Results. KD therapy was effective in 69.05% of cases. No significant correlation was observed with the type of diet used. KE was related to greater effectiveness after KD treatment. KD treatment was most effective in the reduction of non-focal seizures. Considering the ILAE proposed classification, it was found that KD efficacy was higher in patients with simultaneous focal and tonic-clonic seizures compared to patients with only tonic-clonic or focal seizures. Conclusion. The occurrence of focal seizures does not determine the potential ineffectiveness of treatment with a ketogenic diet. A significant efficacy of ketogenic diet treatment was observed in the group of patients with focal and generalized seizures, as well as epileptic and developmental encephalopathies. The etiology of epileptic seizures plays a more significant role. The new classification will make it easier to select patients who can benefit from this form of treatment.

Highlights

IntroductionPublisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations
It can be concluded that treatment with the ketogenic diet (KD) is a safe and effective form of epilepsy therapy
The most significant benefit from this form of treatment can be expected in patients who have both focal and generalized seizures, that is, in a group of patients with developmental and epileptic encephalopathies of known molecular or cytogenetic background

Summary

Introduction

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. The ketogenic diet (KD) is a high fat, low carbohydrate, and adequate protein (1 g/kg) diet that has been presented as a possible treatment method for epilepsy since the 1920s [1,2]. A century of clinical observations and decades of research studies have suggested the possibility of using the KD to render neuronal network functions resistant to high electrical activity [3,4]. The ketogenic diet has been sidelined for a long time due to the widespread development and use of antiseizure drugs (ASDs). DEPDC5—3 SLC2A1—5 SYNGAP1—1 Diagnosis DS.—2 JAE—1 AS-like—1 DS.—1 LGS—1 RS-like—1 ≤50%

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